Letter to the Editor: Dementia Care in Japan: Insurance for Long‐term Care Legislation in Japan

We read with interest, Ineichen's article on dementia care in China, which stated the need for a greater commitment from the country to challenge the increase in the number of elderly with dementia (Ineichen, 1998). Japan is trying to cope with an impending surge of dementia by launching the new long-term care (LTC) insurance, which became law in December 1997. The implementation of LTC insurance, which will be in the year 2000, is considered epoch-making in the sense that the amount of care provided is regardless of available family care (Arai, 1997). However, with this impending implementation of LTC insurance, several problems have already been identi®ed in relation to dementia care. First, the prerequisite for the new system to function is a cadre of health and social professionals who will assess eligibility level and determine care planes, ie `care managers'. However, education and training in such skills has long been non-existent for doctors and other professionals in Japan. In particular, `psychogeriatrics' is not fully recognized as a speciality. Among the 80 medical schools, in Japan, only 12 have declared `one of their research interests' (Chugai Seiyaku, 1997). Also, the education and training courses for these new `care managers' which the government is currently providing place little emphasis on methods for screening dementia in the community. Thus, there is a possibility that these `care managers' may not be able to identify those with dementia residing in a community. Second, people are still hesitant about using social services. We conducted a survey in Matsuyama, in the Miyagi prefecture, located in northern Japan, which was aimed at investigating the way in which the elderly themselves think about service utilization. A seminar on care of the demented elderly was conducted which was announced in an ocial circular published by the municipal government. Out of the 1427 older than 65 years and not registered as the disabled elderly, 112 attended the seminar. Ninety-eight subjects returned the questionnaire. First, 42% of the subjects replied that they did not want their family members to use social services even if they were to su€er from dementia. There were no signi®cant di€erences between males and females. Interestingly, however, those who had had caring experiences tended to answer that they wanted their family members to use social services (w2ˆ 2.88, dfˆ 1, pˆ 0.08). Despite the stigma attached to social services, it seemed that former carers (caregivers) were not hesitant about using the services. Second, only 56.1% knew about LTC insurance. Our sample was an opportunistic one consisting of those who would be more aware of the problems in an ageing society; our subjects attended our seminar. Thus, it is surprising that only half of the subjects were aware of LTC insurance, which is often described as `one of the most radical reforms in health and social care in post-war Japan'. Our conclusions are twofold. First, courses in psychogeriatrics with the emphases on e€ective screening for those with dementia should be provided to potential `care managers'. Second, the municipal government should take measures (1) to reduce the stigma attached to service utilization; and (2) to increase awareness of the new LTC insurance in the community, if LTC is to be successfully implemented.